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insurers may have a preferred billing form (e.g., CMS-1500 or CMS-1450/UB-04), a provider which uses a different form or an invoice to submit a bill that is otherwise payable is nonetheless entitled to timely payment and interest if the bill is not paid timely.
Bulletin 2021-36-INS acknowledges that an insurer that receives a bill for which reimbursement must be calculated under MCL §500.3157(7) may request a charge description master or “average amount” from a provider to calculate the reimbursement amount, but must request this information as promptly as possible and in no event later than the time frames set forth in MCL §500.3142. The insurer must reimburse the provider promptly upon receipt of the required documentation.
Bulletin 2021-36-INS also acknowledges the Department’s awareness of situations in which insurers have repeatedly rejected providers’ bills solely because the insurer believes the provider did not correctly code the services rendered. As stated in Bulletin 2021-35-INS, the Department’s position is that insurers are expected to engage in a dialogue with providers to assist them in understanding the insurer’s review of the provider’s bills and to expedite bills resubmitted with corrected codes.
Bulletin 2021-36-INS also addresses enforcement and states that the Department may consider any of the following to be a pattern of conduct by insurers in violation of MCL §500.2026: repeatedly refusing to pay claim amounts that are not reasonably in dispute; insisting on a specific form as the sole basis for refusing payment; rejecting bills repeatedly without offering assistance to a provider; or repeated violations of MCL §500.3142. Insurers found to be in violation of these provisions of the Insurance Code will be subject to administrative action initiated by the Department.
https://www.michigan.gov/documents/difs/Bulletin_2021-36-
Bulletin 2021-37-INS
Bulletin 2021-37-INS, issued on October 6, 2021, notifies interested parties of resources the Department has made available as a convenience to assist providers and auto insurers in applying the fee schedule set forth in MCL §500.3157. These resources are available on the Department’s website.
One of the available resources is a bulletin board where non-hospital providers may post their charge description masters and average amounts charged as of January 1, 2019, in order to facilitate payment under MCL §500.3157(7). Providers may submit these documents to DIFS-PA2122@michigan.gov. Submission of charge description masters and average amounts is voluntary. Documents will not be edited or redacted and will be posted as received. The Department will not authenticate the charge description masters or average amounts and the submitting party remains solely responsible for any information contained in them. Providers should be aware that any documents submitted may be relied upon by an insurer to process claims, and that knowingly submitting false or misleading documents may constitute a fraudulent insurance act under MCL §500.4503. The Department will continue to post fee schedule resources as they become available. Providers and insurers are encouraged to check back regularly for updates.
†https://www.michigan.gov/documents/difs/Bulletin_2021-35- INS_736298_7.pdf
‡https://www.michigan.gov/documents/difs/FIS- PUB_8520_732469_7.pdf?
*Patrick J. Haddad and Kathleen A. Westfall are members of Kerr, Russell and Weber, PLC. Their legal practices focus on health care and insurance. Kerr Russell is legal counsel to the Oakland County Medical Society. For more information about this article, Mr. Haddad or Mrs. Westfall may be contacted at (313) 961-0200, phaddad@kerr-russell.com or kwestfall@kerr- russell.com. This publication is furnished for informational purposes only, and receipt hereof does not establish an attorney-client relationship. It does not communicate legal advice by the Oakland County Medical Society, Mr. Haddad, Mrs. Westfall or Kerr Russell. © 2021 Kerr, Russell and Weber, PLC
§ INS_737573_7.pdf
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DECEMBER 2021/JANUARY 2022 | WWW.OCMS-MI.ORG
Questions regarding the three Bulletins should be directed to the Department of Insurance and Financial Services, Office of Consumer Services, P.O. Box 30220, Lansing, Michigan 48909-7720. The Department may be called at (877) 999-6442.